Catholic Healthcare Partners' (CHP) previous proposal to AHRQ entitled "Heart Failure (HF) GAP (Guidelines Applied in Practice)" has been highly successful to date. Phase 1 has thus far consisted of both planning and active implementation of a comprehensive quality improvement effort for patients with chronic HF in accordance with national priorities recently set forth by the Institute of Medicine. Current major aims of this project include: (1) Adaptation of nationally published HF guidelines and associated quality measures for the Catholic Healthcare Partners system, consisting of 31 hospitals located in 5 states (which discharged over 8.000 patients with HF during calendar year 2003); (2) Development of a knowledge transfer framework to implement guidelines and motivate significant quality improvements for care of patients with chronic HF; (3) Development and implementation of a prototype for computerized physician order entry ("CPOE") systems that support the first and second aims, especially in the context of managing a chronic disease state such as HF, and (4) Demonstration of CHP's ability to establish and sustain effective, broad-based partnerships among a variety of diverse health care organizations, provider groups, professional medical societies and health care information technology corporations and their stakeholders. Phase 2 goals for the CHP HF GAP initiative include a larger focus on outpatient care coordination, support infrastructure and clinical quality improvement processes for patients with chronic HF. Additional areas of development, description and evaluation include expanding the use of quality measurement for chronic HF care to outpatient settings; defining the impact and acceptance of emerging chronic HF disease management programs; the influence of external and organizational incentive payments for demonstrating measurable quality improvement; the fostering of clinical cardiology leadership to promote quality improvements for chronic HF care; overcoming current health system challenges, especially those with potentially negative financial implications, for implementing quality improvement interventions that enhance self-management; and demonstrating improved quality of life, including the promotion of palliative care services for those patients with advanced chronic HF who are at or near the end of life.